In this video, Dr. Anker and Dr. Marshall discuss the role of Electroconvulsive Shock Therapy (or ECT) in management of MDD. Many people fear ECT based on misconceptions promoted by popular culture. In truth, it may be more effective for many patients with MDD than any available antidepressant. Often patients can achieve complete or significant remission for MDD within just three or four weeks. The use of powerful medications that can temporarily paralyze the muscles has made ECT much safer than in the past, eliminating the risk of broken bones or suffocation patients faced 50 years ago. ECT applies a low-level shock to one or both temples that causes a seizure that lasts at least 30 seconds. The patient is put to sleep and the procedure takes place in a preoperative area with an anesthesiologist available. Typically, a patient receives three sessions a week for a total of 12 to 16 sessions. Side effects may include headache and short-term memory loss. It is very safe and may be the treatment of choice for patients who are pregnant, actively suicidal or need rapid relief from MDD for other reasons.
This animation explains that the goal of MDD therapy is to help restore healthy functioning of the brain and healthy quality of life. There are several types of management options for MDD and your doctor can discuss these with you, including counseling therapy, lifestyle changes like diet, sleep and exercise, certain medications, and other options where appropriate.
The primary goal in treating depression is to achieve remission or give a patient complete relief from all symptoms. Drs. Anker and Marshall explain in this video that a partial remission can also be a good outcome of treatment. If the symptoms are easier to deal with and milder than before, then you can go back to work, take care of your children and generally resume your life. With counseling, you may find that with full or partial remission you function even better than you did before treatment for MDD.
Lifestyle makes a big difference in managing and reducing the risk of major depressive disorder, explain Dr. Anker and Dr. Marshall in this video. If you have a genetic tendency toward depression, controlling your environment to reduce stress and provide structure is very important. A few steps can really help:
If you have MDD, finding the right counselor and the best therapy can really help. As Drs. Anker and Marshall explain in this video, every patient has unique issues that make them better suited to some therapies than to others. If you have experienced intense grief that led to MDD, someone with grief counseling experience may be most helpful. If you feel hopeless and have trouble finding anything positive in your life, cognitive-behavioral therapy may help you find new hope and a more positive perspective. A psychiatrist can also provide support and help empower you to find new solutions to long-standing problems.
Dr. Anker and Dr. Marshall discuss the major classes of antidepressants in this video and the value of psychotherapy. If you have a milder form of MDD, psychotherapy may be the best treatment. It helps patients learn how to solve problems, reduce and manage their responses to stressors, and make positive lifestyle changes. If you have moderate to severe MDD, psychotherapy remains important, but you should also start on an antidepressant medication to manage the symptoms. Older antidepressants include tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) make up the newer classes of antidepressants. These generally have fewer side effects than the older drugs. While research has shown that all the antidepressants reduce symptoms of depression in many people, you may need to try one or two or more before you find one that works well for you. Alternatively, you may need to take more than one antidepressant to fully manage your symptoms. Communicate regularly with your psychiatrist about how you feel and any side effects you experience as you work together to find a medication regimen that works for you.
If you have MDD, you need to work with a doctor who looks at your treatment as a partnership. As Drs. Anker and Marshall explain in this video, your doctor should be willing to spend time discussing how you are feeling and talking to you about treatment options and lifestyle changes. Other topics you want to make sure to discuss include whether you are taking the right dosage or the right medicine based on your response, and whether you are experiencing any side effects from medication. To start with, you will ideally see your psychiatrist every week during a major depressive episode—at a minimum, every other week—for an hour initially, then for at least 20-30 minutes a visit until you start to feel better.